My Cat's Meow

Your name* This field is required.This information will not be made public

First Name

Last Name

Your email* This field is required.This information will not be made public

example@example.com

Cat's Name* This field is required.

DOB/Age:* This field is required.Approximate is okay

Sex* This field is required.

Female

Male

Is this cat spayed/neutered?* This field is required.

Yes

Unknown

Breed(s) (or best guess) / Color* This field is required.

Is this cat declawed?* This field is required.

Yes, 2 paws

Yes, 4 paws

Reason for Surrender* This field is required.Please be as specific as possible

Where does this cat spend their time?* This field is required.

Inside only

Outside only

Inside and outside

What other animals does this cat live with?* This field is required.

Cats

Dogs

Other

You selected 'other'* This field is required.What other animals does this cat live with?

What type of food does this cat eat?* This field is required.

Dry cat food

Wet cat food

Dry mixed with wet

Special diet

You selected 'special diet'* This field is required.Please explain

How often/how much does this cat eat?* This field is required.

Once daily

Twice daily

Free fed

How much does this cat shed?* This field is required.

A lot

Moderate

Very little

Are you able to clip the nails?* This field is required.

Never tried

Yes- by myself

Yes- with a helper

Describe how your cat does when groomed* This field is required.(Baths, brushing fur, cleaning ears, etc.)

Does your cat have accidents in the house?* This field is required.

YESNO

What kind of litter box does this cat use?* This field is required.

Covered box

Uncovered box

Auto-cleaning

How many litter boxes? Where are they? For how many cats?* This field is required.

What type of litter is used?* This field is required.

Unscented

Scented

Clumping

Non-clumping

What brand of litter is used?* This field is required.

How often do you clean the litterbox?* This field is required.

What % of the time does your cat use LB for
defecation: number * %.
urination: number * %

Other than LB, where is your cat
defecating: blanks *
urinating: blank *

When did you first notice the elimination problem?* This field is required.

Has the problem:* This field is required.

Increased

Decreased

Remained the same

Is there a noticeable pattern as to when the cat eliminates outside the LB?* This field is required.(time of day? home alone?)

YESNO

You selected 'yes'* This field is required.Describe the pattern as to when the cat eliminates outside the LB

Is this cat:* This field is required.

Spraying (standing position with urine landing on vertical surfaces)

Squatting (sitting position with urine landing on horizontal surfaces)

Have other animals used these same spots for inappropriate eliminations?* This field is required.

YESNO

What kind of surface is targeted?* This field is required.

Carpet

Wood

Vinyl

Tile

Human's bedding/clothing

A person

Bath/shower/sink/basin

Another pet's items

Other

You selected 'other'* This field is required.What other surfaces are targeted?

Have you caught this cat "in the act?"* This field is required.

YESNO

Does this cat have access to LB 24/7?* This field is required.

YESNO

How many cats are in your household?* This field is required.

How many litter boxes are in the household?* This field is required.

How many rooms are the litter boxes located in?* This field is required.

Has this cat had a negative experience (medicated, scared, ambushed by other cat, etc.) near LB?* This field is required.

YESNO

Is LB in noisy (appliances, road, etc.) or busy location or by window? * This field is required.

YESNO

You selected 'yes'* This field is required.Please explain

Where are the food and water bowls relative to LBs?* This field is required.

Are any of the LBs a type or shape other than standard rectangular?* This field is required.

YESNO

You selected 'yes'* This field is required.Describe LB type/shape

What are the dimensions of your LBs (Length, Width, Height in inches)
1.    Length *     Width *     Height *
2. (Additional LB)    Length *     Width *     Height *
3. (Additional LB)    Length *     Width *     Height *

Do LBs have:* This field is required.

Hoods/covers

Automated mechanisms

Liners - unscented

Liners - scented

Which kind of litter?* This field is required.

Clumping

Non-clumping

Sand/clay

Pellets

Crystals

Other

You chose 'other'* This field is required.What other kind of litter is used?

Is the litter scented?* This field is required.

YESNO

What is the approximate depth of litter typically in the LBs, in inches?* This field is required.

How often do you scoop the LB?* This field is required.

How often do you clean the LB?* This field is required.

How often do you replace the litter?* This field is required.

Do you store dirty litter next to the LB?* This field is required.

YESNO

You selected 'yes'* This field is required.How often to you empty the dirty litter bin?

Do you use anything other than soap and water to clean the LBs?* This field is required.

YESNO

You selected 'yes'* This field is required.What do you use to clean the LBs?

What are you using to clean the areas of inappropriate elimination?* This field is required.

Will this cat immediately use a freshly cleaned LB?* This field is required.

YESNO

Does this cat spend time outside?* This field is required.

YESNO

Did you move, remove, or otherwise physically modify LBs locations?* This field is required.

YESNO

You selected 'yes'* This field is required.Please explain

Did you change any of these before the problem started?* This field is required.

Brand of litter

Type/texture of litter

LB style

Any changes or stresses from your cat's point of view?* This field is required.

New schedule

Household move

New baby

Baby became "mobile"

Person added/subtracted from home

Pet added/subtracted from home

Other

You chose 'other'* This field is required.What other changes or stresses from your cat's point of view?

Does this cat:* This field is required.

Strain when peeing/pooping

Have blood in the urine/stool

Lick the genital area excessively

Crouch for a long time to pee/poop

Cry during peeing/pooping

Balance on the edge of LB to eliminate

Is this cat drinking more water than usual?* This field is required.

Don't know

Yes

Type option 4

Is your cat displaying other signs?* This field is required.

Appetite loss

Weight loss

Vomiting

Diarrhea

Listlessness

What have you done thus far to try to solve this problem?* This field is required.

Changed type of litter

Changed type of LB

Added LB

Took cat to the vet

Used Feliway

Separate cat from other animals

New LB location

Other

You selected 'other'* This field is required.What else have you done thus far to try to solve this problem?

Is there anything else you feel may be relevant to this problem?* This field is required.

How does this cat interact with other cats?* This field is required.If this does not apply, type "N/A"

How does this cat interact with dogs?* This field is required.If this does not apply, type "N/A"

Where does this cat like to be touched?* This field is required.

Where does this cat NOT like to be touched?* This field is required.

Does this cat like to be picked up?* This field is required.

YESNO

What are this cat's favorite toys/activities?* This field is required.

How does this cat behave with adult family?* This field is required.

No other adult family

Friendly

Playful

Plays gently

Plays rough

Cuddly

Reserved

Shy

Fearful

Aggressive

Unknown

You selected 'fearful' and/or 'aggressive'* This field is required.Please explain this cat's behavior with adult family

How does this cat behave with family aged 9-17 years?* This field is required.

No family aged 9-17 years

Friendly

Playful

Plays gently

Plays rough

Cuddly

Reserved

Shy

Fearful

Aggressive

Unknown

You selected 'fearful' and/or 'aggressive'* This field is required.Please explain this cat's behavior with family aged 9-17 years

How does this cat behave with family aged 0-8 years?* This field is required.

No family aged 0-8 years

Friendly

Playful

Plays gently

Plays rough

Cuddly

Reserved

Shy

Fearful

Aggressive

Unknown

You selected 'fearful' and/or 'aggressive'* This field is required.Please explain this cat's behavior with family aged 0-8 years

How does this cat behave with adult visitors to the home?* This field is required.

No adult visitors

Friendly

Playful

Plays gently

Plays rough

Cuddly

Reserved

Shy

Fearful

Aggressive

Unknown

You selected 'fearful' and/or 'aggressive'* This field is required.Please explain this cat's behavior with adult visitors to the home

How does this cat behave with visitors to the home aged 9-17?* This field is required.

No visitors aged 9-17

Friendly

Playful

Plays gently

Plays rough

Cuddly

Reserved

Shy

Fearful

Aggressive

Unknown

You selected 'fearful' and/or 'aggressive'* This field is required.Please explain this cat's behavior with visitors to the home aged 9-17?

How does this cat behave with visitors to the home aged 0-8?* This field is required.

No visitors aged 0-8

Friendly

Playful

Plays gently

Plays rough

Cuddly

Reserved

Shy

Fearful

Aggressive

Unknown

You selected 'fearful' and/or 'aggressive'* This field is required.Please explain this cat's behavior with visitors to the home aged 0-8?

Is this cat afraid of:* This field is required.

Strangers

Baths

Vacuum

Loud Noises

Car Rides

Vet visits

Other

You selected 'other'* This field is required.What else is this cat afraid of?

Does this cat tend to:* This field is required.

Jump on countertops/tables

Scratch

Bite

Chew plants

Door dash

Vocalize

Scratch carpet/furniture

Stay active at night

Climb trees

Other

You selected 'other'* This field is required.List other behaviors this cat engages in

How would you describe your cat most of the time?* This field is required.Select all that apply

Easygoing

Needy

Active

Affectionate

Picky

Nervous

Curious

Lap cat

Outgoing

Feisty

Talkative

Quiet

Solitary

A clown/silly

Anxious

Explorer

Escape artist

Couch potato

Extremely shy

Other

You selected 'other'* This field is required.How else would you describe this cat most of the time?

Has this cat ever bitten anyone?* This field is required.

YESNO

You selected 'yes'* This field is required.Describe the situation(s) where this cat has bitten

What is this cat's medical history?* This field is required.

100

Who was this cat's veterinarian?

Veterinarian name and/or clinic

Veterinarian/clinic's phone number

101

Please sign here so we can access this cat's vet records

Clear

102

Please add any additional information that you feel would be helpful for us or a new owner to know about this cat.* This field is required.

103

May the new owner contact you for further information?* This field is required.

YESNO

104

Please leave your name and phone number for the new owner to contact you for further information:* This field is required.

First name

Phone number